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BACKGROUND: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. METHODS: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39–69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2–14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. RESULTS: There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. CONCLUSIONS: Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.
Subject(s)
Female , Humans , Male , Anti-Inflammatory Agents, Non-Steroidal , Christianity , Immobilization , Magnetic Resonance Imaging , Rupture , Splints , Tears , Tendinopathy , Tendons , UltrasonographyABSTRACT
Objective To explore the effect of the temperature-sensitive hydrogel and platelet-rich plasma(PRP)complex on the healing of anterior cruciate ligament (ACL)partial tear in a rat model.Method PRP was processed according to an established method and then mixed with poly(ethylene glycol)monomethyl ether and poly(lactic-co-glycolic acid)(mPEG-PLGA).A total of 110 right knees of Sprague-Dawley male rats (12-week old)were included and randomly divided into a healthy control group (n=10),a lesion control group(n=60)and a study group(n=40).The saline and mPEG-PLGA-PRP complex was applied at the lesion site respectively.Samples were harvested 0,2 weeks and 6 weeks post-operatively and the histological and biomechanical changes were observed and compared among the 3 groups.Results Histologically,at 6 weeks after surgery,the torn ACL of the study group had been partially healed,with decreased number of inflammatory cells and new fibrous tissues and micro-vessels appearing.The ligament maturity index revealed a significantly higher score in the study group than the lesion control group(20.6 ± 4.9 vs.4.7 ± 1.0,P＜0.01).Biomechanically,at 6 weeks after surgery,the tensile strength of the study group was significantly higher than the contro] groups(52.7 ± 11.2 vs.30.3 ± 8.8,P＜0.05).Conclusion At six weeks after surgery,the mPEG-PLGA-PRP complex can enhance the healing of ACL partial tear,ahhough the ligament was not recovered to the norma] state.
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Objective To compare the outcomes between radiofrequency modification and augmentation reconstruction in the treatment for partial anterior cruciate ligament( ACL) tears. Methods Fifty?four patients with partial ACL tears were divided into radiofrequency modification group( n=16) and augmentation reconstruc?tion group( n=38) according to different treatment methods. Minimum follow?up was 2 years. Patients were eval?uated just after the injury and at the latest follow?up with several parameters, including the international knee documentation committee( IKDC) score,Lysholm knee score,Tegner activity rating,range of motion ( ROM) and the kneelax arthrometer. Results The kneelax was (4. 4±0. 9) mm of preoperative, (5. 0±1. 5) mm of post?operative in radiofrequency modification group,the difference was no signifiacnt( t=1. 372,P=0. 183);in aug?mentation reconstruction group was (4. 7±0. 8) mm and (1. 7±1. 0) mm respectively,the knee stability was in?crease significantly postoperative;knee stability was significantly improved in the augmentation reconstruction group compared with the radiofrequency modification group( t=9. 228,P=0. 000) . In radiofrequency modifica?tion group,ROM,Lysholm score and Tegner score were improved significantly between the results pre?and post?operatively((105. 4±22. 5)° vs. (123. 5±11. 4)°,t=59. 189,P=0. 000;65(51,90)) points vs. 86(59,100) points,Z=3. 852,P=0. 000;3(1,5) points vs. 6(1,9) points,Z=4. 637,P=0. 000). In augmentation recon? struction group, ROM,Lysholm score and Tegner score were improved significantly between the results pre?and post?operatively((99. 4±21. 9)° vs. (125. 3±10. 9)°,t=6. 527,P=0. 000;(65(51,89) points vs. (85 (59, 100) points,Z=4. 427,P=0. 000;3(1,5) points vs. 6(1,9) points,Z=3. 961,P=0. 000). Conclusion Augmentation reconstruction technique is more beneficial to the knee stability than radiofrequency modification in the treatment for the partial ACL tears.
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El hombro es una articulación muy móvil, lo cual predispone a múltiples patologías, entre ellas las lesiones del manguito rotador, siendo ésta una causa frecuente de dolor y limitación funcional. Para su valoración se realiza una anamnesis, un examen físico del hombro, múltiples maniobras con diferentes niveles de especificidad y sensibilidad, estudios de imagen como rayos X, ecografía, y resonancia magnética. El conocimiento y tratamiento de las rupturas del manguito rotador está mejorando progresivamente, con la evolución de técnicas de reparación artroscópicas...
The shoulder is a very mobile joint, which predisposes to multiple pathologies including rotator cuff injuries. It is a common cause of pain and functional limitation. To explore the shoulder we use the anamnesis, physical examination, multiple maneuvers with different levels of specificity and sensitivity, and imaging studies such as X-rays, ultrasound, and MRI. The knowledge and treatment of rotator cuff ruptures is improving gradually, with the development of arthroscopic repair techniques...
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Humans , Shoulder , Shoulder FracturesABSTRACT
BACKGROUND: To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. METHODS: The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. RESULTS: The mean (+/- standard deviation) age of the 20 enrolled patients was 56.0 +/- 7.7 years. The forward flexion strength increased from 26.3 +/- 6.7 Nm preoperatively to 38.9 +/- 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 +/- 1.7 to 19.1 +/- 3.03 Nm, 12.3 +/- 3.2 to 18.1 +/- 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). CONCLUSIONS: The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthroscopy/adverse effects , Follow-Up Studies , Magnetic Resonance Imaging , Muscle, Skeletal/injuries , Pain Measurement , Range of Motion, Articular , Rotator Cuff/injuries , Statistics, Nonparametric , Treatment OutcomeABSTRACT
OBJECTIVE: To compare the ultrasonographic findings of chronic lateral epicondylitis of elbow with partial tear of common extensor tendon before and after prolotherapy. METHOD: The subjects were 12 cases of chronic lateral epicondylitis with partial tear of common extensor tendon, which were confirmed by ultrasonography. We examined the common extensor tendon with ultrasonography at initial visit. After injecting 15% dextrose solution monthly for five times, follow up ultrasonography was performed one month after last injection. RESULTS: Before prolotherapy, every case had anechoic focus without normal fibrillar pattern, which represented partial tear of tendon. Seven cases showed focal or diffuse hypoechoic foci with loss of normal fibrillar pattern of tendon, which represented tendinosis. After prolotherapy, initial anechoic foci were changed to smaller size with diffuse fibrillar pattern inside in 6 cases, to the same the sized hypoechoic foci with diffuse fibrillar pattern inside in 2 cases. And a few fibrillar pattern were seen within the initial anechoic focus in 1 case and most of anechoic foci were filled with fibrillar pattern except small anechoic foci in 3 cases. CONCLUSION: Prolotherapy can help the recovery process of chronic lateral epicondylitis. And ultrasonography can be a useful method to evaluate the therapentic effect of lateral epicondylitis.
Subject(s)
Elbow , Follow-Up Studies , Glucose , Tears , Tendinopathy , Tendons , UltrasonographyABSTRACT
OBJECTIVE: To determine the effect of prolotherapy on lateral epicondylitis, and the difference of treatment effect according to the findings of ultrasonography. METHOD: The subjects were 84 patients who were diagnosed as lateral epicondylitis. The pain score was evaluated by using VAS (Visual Analogue Scale) before treatment and 1 month and 6 months after the 3rd injection. Ultrasonography was done to 49 patients who were suspicious of tendinous tear. RESULTS: In the comparison of the VAS before treatment and after the 3rd injection, it was 6.79+/-0.88, 2.95+/-1.90, respectively, which demonstrated statistical significant decrease (p<0.01). We found more significant reduction of VAS in the subjects without tendinous tear (7.08+/-0.91 to 2.16+/-1.57) than those with partial tendinous tear (6.90+/-0.93 to 3.67+/-1.76) (p<0.01). Among 71 patients whose symptom was improved after the treatment, 57 patients (80.2%) demonstrated sustained improvement at 9 months and 14 patients (19.7%) relapsed at 9 months. CONCLUSION: Prolotherapy is an effective treatment method in the lateral epicondylitis of elbow. Ultrasonography could be a useful diagnostic method which could predict the effect of prolotherapy.
Subject(s)
Humans , Elbow , Tears , UltrasonographyABSTRACT
Purpose of this study was to investigate the biomechanical fates of the partial thickness tear of the rotator cuff in rabbit, and try to provide guideline of treatment for the partial thickness tear of the rotator cuff tendon. Infraspinatus tendons of fifty rabbits were used for study. The rabbits were divided into three groups, twenty for one-third resection(superficial partial resection group), twenty for two-thirds resection(deep partial resection group) and ten for control group. Extraarticular portion of the infraspinatus tendons of the rabbits were resected partially with one-third or two-thirds thickness for each experimental group. We sacrificed five rabbits of each experimental group at 3, 6, 9, and 12 weeks after the resections, and five rabbits for the control group at 6 and 12 weeks. Average maximal load per area of the infraspinatus tendons was measured by tension test. There was significant difference between the deep partial resection group, 5.3 and 6.3 N/emat 6 and 12 weeks respectively, and the control group, 13.2 N/mm(P<0.05). There was no difference between the control and superficial partial resection group, 12.8 and 14.1 N/mm at 6 and 12 weeks, respectively. Shallow partial tears might be healed spontaneously. Deep partial tears would not be healed naturally. When surgical treatment is indicated for deep partial tears of the rotator cuff, tendon repair, rather than debridement, would provide more predictable results.